Limited Reconstructive Options of Jaw Osteomyelitis in the Osteopetrosis Patient Complicated by Blood Dyscrasia.

Abstract

Osteopetrosis is a rare systemic skeletal disorder characterized by increased bone density and mass resulting from suboptimal or impaired resorption of osteoclastic bone. Compromised bone marrow function and associated disorders of red blood cells contribute to hematopoietic abnormalities, which exacerbate the risk of complex, recurrent infections such as jaw osteomyelitis. This case report describes the treatment of a 68-year-old Korean female with autosomal-dominant osteopetrosis who presented with severe and persistent jaw osteomyelitis complicated by hematopoietic dysregulation. Clinical findings included skin necrosis, purpura, and ecchymosis, which were likely due to underlying hematopoietic insufficiency and impaired wound healing. Despite suboptimal conservative interventions, partial mandibulectomy was ultimately unavoidable. Reconstruction was performed with a pectoralis major myocutaneous flap, as microvascular and osteocutaneous flaps were not viable due to limitation of the patient's vessels and bone marrow. Conservative debridement, rigorous wound care, and transfusion support were essential to manage the infection and promote healing. This case underscores the challenges of treating osteomyelitis in patients with osteopetrosis, particularly given the likelihood of systemic hematopoietic compromise and a suboptimal healing environment. Conservative approaches, supportive transfusions, and close monitoring of the skin and hematological complications are vital for achieving favorable outcomes.